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The failure of the levator hiatus (LH) and urogenital hiatus (UGH) to remain closed is not only associated with pelvic floor disorders, but also contributes to recurrence after surgical repair. Pregnancy and vaginal birth are key events affecting this closure. An understanding of normal and failed hiatal closure is necessary to understand, manage, and prevent pelvic floor disorders.This narrative review was conducted by applying the keywords "levator hiatus" OR "genital hiatus" OR "urogenital hiatus" in PubMed. Articles that reported hiatal size related to pelvic floor disorders and pregnancy were chosen. Weighted averages for hiatal size were calculated for each clinical situation.Women with prolapse have a 22% and 30% larger LH area measured by ultrasound at rest and during Valsalva than parous women with normal support. Women with persistently enlarged UGH have 2-3 times higher postoperative failure rates after surgery for prolapse. During pregnancy, the LH area at Valsalva increases by 29% from the first to the third trimester in preparation for childbirth. The enlarged postpartum hiatus recovers over time, but does not return to nulliparous size after vaginal birth. Levator muscle injury during vaginal birth, especially forceps-assisted, is associated with increases in hiatal size; however, it only explains a portion of hiatus variation-the rest can be explained by pelvic muscle function and possibly injury to other level III structures.Failed hiatal closure is strongly related to pelvic floor disorders. Vaginal birth and levator injury are primary factors affecting this important mechanism.

Background Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Using a novel electronic reporting tool, we aimed to prospectively describe the onset of tofacitinib efficacy during induction therapy in a real-world study. Methods Patient-reported outcome data (PROs) including the simple clinical colitis activity index (SCCAI), PRO Measurement Identification Systems (PROMIS) measures, and adverse events were collected daily for the first 14 days and at day 28 and 56. Paired t tests and P for trend were utilized to compare changes in SCCAI over time. Bivariate analyses and logistic regression models were performed to describe response (SCCAI Results Of all included patients (n = 96), 67% had failed ≥2 biologics, and 61.5% were on concomitant steroids. Starting at day 3, PROs showed significant and persistent decline of the mean SCCAI (−1.1, P < 000.1) including significantly lower SCCAI subscores for stool frequency (−0.3; P < .003), bleeding (−0.3; P < .0002) and urgency (−0.2; P < .001). Steroid-free remission at day 14, 28, and 56 was achieved in 25%, 30.2%, and 29.2% of patients, respectively. Neither prior biologics nor endoscopic severity were independently predictive of response or remission in multivariate models. Numeric improvements in all PROMIS measures (anxiety, depression, social satisfaction) were seen through day 56. Rates of discontinuation due to adverse events were low. Conclusions In this prospective real-world study, tofacitinib resulted in a rapid and persistent improvement in UC disease activity PROs. The safety findings were consistent with the established safety profile of tofacitinib.

Characterizing food pantry (FP) clients’ FP usage patterns may provide opportunities to tailor health-related interventions. Respondents (n = 245) at seven FPs reported their frequency and reliance on FPs and their sociodemographics, health status, and health-related trade-offs. Clients were categorized via latent class analysis. Higher FP usage was associated with being older, having a household member with heart disease, and putting off buying medicine to buy food. Lower FP usage was associated with higher levels of education and having a household member with cancer. Findings highlight the potential importance of measuring FP clients’ degree of FP use.

Latinx and Marshallese populations experienced significant COVID-19 disparities in Arkansas, as well as high rates of food insecurity. This case study describes a partnership to rapidly deliver foo...

Objective:Food insecurity is associated with a greater risk of depression among low-income adults in the USA. Members of food-insecure households have lower diet diversity than their food-secure counterparts. This study examined whether diet diversity moderates the association between food insecurity and depression.Design:Multiple logistic regression was conducted to examine independent associations between food insecurity and depression, between diet diversity and depression, and the moderating effect of diet diversity in the food insecurity–depression link.Setting:Cross-sectional data from the National Health and Nutrition Examination Survey (2013–2014).Participants:2636 low-income adults aged 18 years and older.Results:There was a positive association between food insecurity and depression among low-income adults. Diet diversity was not associated with depression. Diet diversity had a moderating effect on the association between food insecurity and depression among low-income adults.Conclusions:Food insecurity is independently associated with depression among low-income adults in the USA. However, this association differs across levels of diet diversity. Longitudinal studies are needed to confirm the role diet diversity may play in the pathway between food insecurity and depression.

Objective Use process and outcome evaluation techniques to evaluate a Sodium Reduction in Communities Program implemented with 58 schools, 17 early childhood education (ECE) centers, and 5 community meals programs across northwest Arkansas. Use of Theory or Research Increased sodium consumption is associated with increased risk of hypertension and cardiovascular disease, and sodium reduction is associated with numerous health benefits. Community-based participatory research and behavioral economics approaches were used to develop tailored strategies to reduce sodium. Target Audience The target audience includes program staff, K-12 and ECE students and staff, low-income individuals accessing community meals, and managers of partner programs. Program Description A variety of sodium reduction strategies, including ingredient substitutions, meal/menu modifications, standardized purchasing lists, and behavioral economics were implemented across all sites to reduce the sodium content of meals. Evaluation Methods To evaluate program implementation, data were collected at baseline and annually thereafter. Evaluation data were collected via detailed menu information, production records, point-of-sale records, purchasing lists, and interviews with program staff. Each year, evaluation findings are used to improve program activities. Results The program now reaches more than 50,000 individuals per day. To date, 90 menu items have been affected by recipe modification across all sites. From Baseline to Year 3, the sodium content of entrees offered, entrees served, and meals served in schools decreased 13.5%, 4.7%, and 3.8%, respectively. Among ECEs and community meals, the sodium content of meals offered and meals served decreased 39.4% and 18.8%, respectively, from Baseline to Year 3. Conclusion Sodium reduction strategies in schools, ECEs, and community meals programs lead to a reduction in sodium served to students, staff, and clients. The program will continue to be expanded and enhanced using process and outcomes evaluation findings, ultimately leading to a reduction in sodium consumption and chronic disease incidence in northwest Arkansas. Funding Centers for Disease Control and Prevention.

Objectives: In this study, we assessed the effect of Family Diabetes Self-Management Educa- tion (DSME) intervention on changes in self-care behaviors among Marshallese adults with type 2 diabetes. Methods: Marshallese adults (N = 211) with type 2 diabetes were randomized to a Family DSME intervention or a Standard DSME intervention. We assessed changes in diabetes- related self-care behaviors from baseline to 12 months within and between study arms using descriptive statistics and mixed effects logistic regression models adjusted for demographic characteristics and use of diabetes medication. Results: Family DSME participants had increased engagement in glucose monitoring and doctor visits, whereas Standard DSME participants had increased engagement in glucose monitoring. Family DSME participants increased engagement in glucose monitoring more than Standard DSME participants. Conclusions: DSME can improve some diabetes related self-care behaviors. Future studies on diabetes management should consider developing and testing interventions that seek to improve long-term rates of engagement in self-care behaviors.

Background Farm to Institution (FTI) programs and policies aim to increase utilization of locally grown and processed food products in institutions such as colleges, schools, hospitals, state agencies, and other private and public entities. FTI's goal is to spur local economic development through engaging regional farms and producers, and to provide healthier, fresher food choices. This project aimed to examine the current state of FTI in Arkansas and highlight opportunities for further development. Objective To determine motivators, barriers, and strategies for reaching local food procurement goals in institutions in Arkansas following the passing of statewide FTI reporting and procurement legislation. Study Design, Setting, Participants We surveyed 1,980 Arkansas institutions including schools, universities, state agencies, and childcare centers in a web-based survey. Eligibility for the survey required that an institution receive at least $25,000 in state funding and offer a food service program. Of the recipients who completed the screener (22%; n = 454), 9% (n = 176) met the criteria for eligibility and completed the survey. Measurable Outcome/Analysis Questions explored food budget, agency commitment, motivators, barriers, and plans for future procurement. Data was compiled and analyzed using REDCap. Results Current local food procurement was approximately 15% for institutions completing the survey. Commonly reported approaches for increasing this percentage include local engagement with farms, farmers’ markets, and vendors; learning more about legislative requirements; and improving local food tracking methods. Institutions also highlighted significant barriers of food supply as well as knowledge of where and how to purchase local foods. Conclusion In 2019, Arkansas passed Act 796, which institutes a goal of at least 20% of an agency's purchases of food products be spent on local farm and food products, and requires institutions to annually report spending. Our findings provide a baseline for FTI in Arkansas under Act 796, and highlight a variety of important opportunities for further expansion, evaluation, and programing to improve FTI at multiple levels within the supply chain. Funding Arkansas Department of Agriculture.

OBJECTIVES: The paper examines the interrelationship among risks, resources, and food insecurity among a post-disaster sample of Hurricane Harvey survivors. Specific hypotheses are tested proposing positive relationships between risk and food insecurity and negative relationships between social and psychological resources and their relationship with food insecurity. METHODS: Random and representative samples were collected among survivors living on the Texas Gulf Coast. Efforts were made to sample and interview survivors in both different cities as well as those experiencing different evacuation circumstances. Both face-to-face interviews and online interviews were used to collect data from 316 survivors. The sample was obtained using quota groupings based on sociodemographic composition and residential location. RESULTS: Both correlation and regression results show support for the general risk and resource hypotheses. Sociodemographic findings show that younger, renters, poorer educated survivors without access to their own transportation reported higher levels of food insecurity in the weeks and months following Hurricane Harvey making landfall in August 2017. Additionally, risks for higher levels of food insecurity were found among persons with higher depressive symptomatology, with higher levels of previous disaster exposure, and reporting a greater concern for climate change. Both strength of social ties and mastery of fate were negatively related to food insecurity, supporting the general resource hypothesis that a greater presence of either social or psychological resources could potentially lower food insecurity among post-disaster survivors. CONCLUSIONS: Our findings lend support to a risk and resources model that has already been applied to food insecurity research in other populations. Its applicability to the resource limited post-disaster setting is important and provides evidence for addressing directly the immediate mental and physical health needs of the population, in addition to the service provider and infrastructural need. Like earlier work, our findings suggest an uneven recovery experience that is likely both dependent on who you are and where you live. FUNDING SOURCES: National Science Foundation.

Pyridostigmine bromide (PB) is an FDA-approved drug for the treatment of myasthenia gravis and a prophylactic pre-treatment for organophosphate nerve agent poisoning. Current methods for evaluating nerve agent treatments include enzymatic studies and mammalian models. Rapid whole animal screening tools for assessing the effects of nerve agent pre-treatment and post-exposure drugs represent an underdeveloped area of research. We used zebrafish as a model for acute and chronic developmental exposure to PB and two related carbamate acetylcholinesterase (AChE) inhibitors, neostigmine bromide (NB) and physostigmine (PS). Lethal doses and gross morphological phenotypes resulting from exposure to sub-lethal doses of these compounds were determined. Quantitative analyses of motility impairment and AChE enzyme inhibition were used to determine optimal dosing conditions for evaluation of the effects of carbamate exposures on neuronal development; ~50% impairment of response to startle stimuli and >50% inhibition of AChE activity were observed at 80 mMPB, 20 mM NB and 0.1 mM PS. PB induced stunted somite length, but no other phenotypic effects were observed. In contrast, NB and PS induced more severe phenotypic morphological defects than PB as well as neurite outgrowth mislocalization. Additionally, NB induced mislocalization of nicotinic acetylcholine receptors, resulting in impaired synapse formation. Taken together, these data suggest that altered patterns of neuronal connectivity contribute to the developmental neurotoxicity of carbamates and demonstrate the utility of the zebrafish model for distinguishing subtle structure-based differential effects of AChE inhibitors, which include nerve agents, pesticides and drugs.

BACKGROUND Depression is the leading cause of diseases globally and is often characterized by a lack of social connection. With the rise of social media, it is seen that Twitter users are seeking Web-based connections for depression. OBJECTIVE This study aimed to identify communities where Twitter users tweeted using the hashtag #MyDepressionLooksLike to connect about depression. Once identified, we wanted to understand which community characteristics correlated to Twitter users turning to a Web-based community to connect about depression. METHODS Tweets were collected using NCapture software from May 25 to June 1, 2016 during the Mental Health Month (n=104) in the northeastern United States and Washington DC. After mapping tweets, we used a Poisson multilevel regression model to predict tweets per community (county) offset by the population and adjusted for percent female, percent population aged 15-44 years, percent white, percent below poverty, and percent single-person households. We then compared predicted versus observed counts and calculated tweeting index values (TIVs) to represent undertweeting and overtweeting. Last, we examined trends in community characteristics by TIV using Pearson correlation. RESULTS We found significant associations between tweet counts and area-level proportions of females, single-person households, and population aged 15-44 years. TIVs were lower than expected (TIV 1) in eastern, seaboard areas of the study region. There were communities tweeting as expected in the western, inland areas (TIV 2). Counties tweeting more than expected were generally scattered throughout the study region with a small cluster at the base of Maine. When examining community characteristics and overtweeting and undertweeting by county, we observed a clear upward gradient in several types of nonprofits and TIV values. However, we also observed U-shaped relationships for many community factors, suggesting that the same characteristics were correlated with both overtweeting and undertweeting. CONCLUSIONS Our findings suggest that Web-based communities, rather than replacing physical connection, may complement or serve as proxies for offline social communities, as seen through the consistent correlations between higher levels of tweeting and abundant nonprofits. Future research could expand the spatiotemporal scope to confirm these findings.

Background Depression is the leading cause of diseases globally and is often characterized by a lack of social connection. With the rise of social media, it is seen that Twitter users are seeking Web-based connections for depression. Objective This study aimed to identify communities where Twitter users tweeted using the hashtag #MyDepressionLooksLike to connect about depression. Once identified, we wanted to understand which community characteristics correlated to Twitter users turning to a Web-based community to connect about depression. Methods Tweets were collected using NCapture software from May 25 to June 1, 2016 during the Mental Health Month (n=104) in the northeastern United States and Washington DC. After mapping tweets, we used a Poisson multilevel regression model to predict tweets per community (county) offset by the population and adjusted for percent female, percent population aged 15-44 years, percent white, percent below poverty, and percent single-person households. We then compared predicted versus observed counts and calculated tweeting index values (TIVs) to represent undertweeting and overtweeting. Last, we examined trends in community characteristics by TIV using Pearson correlation. Results We found significant associations between tweet counts and area-level proportions of females, single-person households, and population aged 15-44 years. TIVs were lower than expected (TIV 1) in eastern, seaboard areas of the study region. There were communities tweeting as expected in the western, inland areas (TIV 2). Counties tweeting more than expected were generally scattered throughout the study region with a small cluster at the base of Maine. When examining community characteristics and overtweeting and undertweeting by county, we observed a clear upward gradient in several types of nonprofits and TIV values. However, we also observed U-shaped relationships for many community factors, suggesting that the same characteristics were correlated with both overtweeting and undertweeting. Conclusions Our findings suggest that Web-based communities, rather than replacing physical connection, may complement or serve as proxies for offline social communities, as seen through the consistent correlations between higher levels of tweeting and abundant nonprofits. Future research could expand the spatiotemporal scope to confirm these findings.

Objective Cigarette smoking is a risk factor for cervical, vaginal, vulvar, and anal dysplasia. We will study the prevalence of cigarette smoking in patients with genital dysplasia and effect of counseling on smoking cessation. Methods All patients with genital dysplasia were screened for smoking history. One clinician provided smoking cessation counseling using the US Department of Health 5 A's technique: ask patients about their smoking status, advise smokers to quit, assess their readiness to quit, assist with their smoking cessation effort, and arrange for follow-up visits. Patients were informed on how smoking may cause worsening of genital dysplasia and increased risk of progression to cancer. Each patient received 2 counseling sessions, but no pharmacological or psychological interventions. Smoking cessation was evaluated by patient self-report via phone or during clinic visits. Results From January 2007 to December 2010, 344 patients were referred to our gynecologic oncology clinic for evaluation of genital dysplasia. Patients who were smokers (n=125, 36%) were counseled to cease smoking in 2 counseling sessions, with 100% compliance for attendance. At study analysis (July 2011), 83 patients still smoke and 40 patients quit smoking (smoking cessation rate of 32%). Caucasian patients (P=.0013) and patients with vulvar dyplasia (P=.411) seemed to smoke more than other races and patients with cervical/vaginal dysplasia respectively. Conclusion Smoking cessation counseling for the genital dysplasia patients who smoked was associated with smoking cessation in 32% of the patients.